Upper GI Bleed

Question 1

What is the presentation of an Upper GI Bleed?

Answer 1

Haematemesis
Melena
Abdominal Discomfort
Dizziness
Sudden Death

Question 2

What is Haematemsis?

Answer 2

This is fresh blood in the vomit and causes from a bleed above the jejenum
Bleeding from below the duodenum/jejenum never produces haematemesis

Question 3

What is Malaena?

Answer 3

Black, tar like stools. Suggestive of an upper GI bleed as the blood has been altered when travelling through the GI tract.

Question 4

Describe the effect of having blood passing through the GI tract?

Answer 4

Acts as a laxative

Causes colicky pain

Question 5

What are the two presentation of bleeding? Which is more common?

Answer 5

Chronic and Acute

Chronic is more common

Question 6

What are some causes of an Upper Gi bleed?

Answer 6

Oesophageal Bleeding
Gastric Bleeding
Duodenal Bleeding

Question 7

What are the causes of Oesophageal bleeding?

Answer 7

GORD
Mallory Weiss Tear
Oesophageal Varices

Question 8

Describe how GORD causes an upper GI bleed?

Answer 8

Produces a small amount of bright red blood due to exposure of the oesophagus to gastric acid

Question 9

Describe how a Mallory Weiss tear causes Upper GI bleeding?

Answer 9

This produces larger volumes of bright red blood. A tear occurs in the oesophageal-gastric junction following prolonged retching and vomiting (usually after alcohol)

Question 10

Describe the causes of a Mallory Weiss Tear?

Answer 10

Chemical Injury (Vomiting, Drinking Bleach)
Infection

Question 11

Describe the treatment of a Mallory Weiss Tear?

Answer 11

Usually resolves on its own without treatment

Question 12

Describe how Oesophageal varices causes Upper GI bleeding?

Answer 12

This produces large amount of dark red blood. This is an affect of severe liver disease causing high blood pressure in the veins which may break.

Question 13

What is the treatment for bleeding Oesophageal varices?

Answer 13

Sclerotherapy
Ligation
Sengstaken Blakemore Tube/Minnesota Tube
Treat underlying liver disease

Question 14

Describe Gastric bleeding?

Answer 14

Erosive Gastritis
Gastric Ulcer
Gastric Cancer

Question 15

Describe Erosive Gastritis

Answer 15

This causes small bleed of fresh blood. Flows NSAID use or a bout of stress. History of dyspepsia

Question 16

Describe Gastric Ulcer

Answer 16

Large bleed, often painless. There is a history of previous smaller bleeds and peptic ulcer disease

Question 17

Describe Gastric Cancer

Answer 17

Small bleed, Anaemia, Dyspepsia and Weight Loss

Question 18

Describe Duodenal Bleeding

Answer 18

Duodenal Ulcers

Duodenal Fistula

Question 19

Describe Duodenal Ulcers

Answer 19

Often accompained by Malaena, H. pylori infection/NSAID use and abdominal pain

Question 20

Describe Duodenal Fistula

Answer 20

Massive haematemesis and PR bleed
Often the result of rupture AAA
Causes death

Question 21

Describe the investigations for an Upper GI Bleed

Answer 21

FBC (Anaemia + Reflux Oesophagitis)
LFTs (Liver Disease - Varcies)
Clotting - Alcohol
OGD (Oesophageal-Gastro Duodenoscopy)

Question 22

Describe peptic Ulcer treatment

Answer 22

Endoscopy
Reduce stomach acid to promote self healing
PPIs and Antibiotics

Question 23

Describe Mallory-Weiss Tear Treatment

Answer 23

Reassurance and discharge (Self Healing)

Question 24

Describe Varices Treatment

Answer 24

Endoscopic Therapy (Sclerotherapy, Banding)
Minnesota Tube Therapy